Kienböck Disease

In the second issue in 2016, the Journal of Wrist Surgery set Kienböck disease as part of the “Special Focus Section.” As an assistant editor, I wrote an editorial for this section, opining that Kienböck disease was well-known, but still had an unknown pathology; it was difficult to arrive at a precise diagnosis at an earlier stage and was difficult to treat. On the whole, we still did not have the perfect answer with regard to the treatment of Kienböck disease. In this section, the following two articles were particularly important: clinical study of radial shortening/closed wedge osteotomy and a study of the use of vascularized bone grafting. I used the title “Kienböck disease: Last frontier of the wrist” for the conclusion of the Special Focus Section. To my understanding, we, wrist surgeons, are tasked with the difficult responsibility of determining the pathology of the wrist in terms of carpal instability, including scapholunate ligament injury, scaphoid fracture/nonunion, triangular fibrocartilage complex (TFCC) lesions and distal radioulnar joint (DRUJ) instability. We have now found pathomechanics to identify these lesions, as several diagnostic tools, including MRI and arthro-CT, and multiple treatment options are based on pathomechanics. In Kienböck disease, pathology is a problem. We are now considering the cause of Kienböck disease to be either deficiency of blood supply to the lunate, overloading of the lunate or multiple minor traumas causing microfracture in the lunate. However, we really do not know the real reason behind this strange disease.

This issue includes the “Special Review” of “Single-cut, single-screw capitate shortening osteotomy for Kienböck's disease” by Dr. Greg Bain. This review describes both the unique and easy technique of single cut, single screw capitate shortening as well as the excellent clinical outcome of this procedure.

Interesting scientific papers relating to the wrist and dealing with medial femoral trochlea osteochondral graft for scaphoid proximal pole nonunion, de Quervain tendinitis surgery, volar locking plate for distal radius fracture and perilunate injury and arthroscopic treatment for scapholunate ligament injury, as well as unique case reports and procedure papers pertaining to arthroscopic radial styloidectomy, are included in this issue. Do not miss it!